This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Thursday, 19 March 2009

Clipboard Carrying Wastes of Space

They make me weep.

Heard a story from a colleague recently. She works at our sister hospital.

On her 36 bed medical ward one Tuesday morning there were only 2 nurses and 3 care assistants on a day shift. As usual they complained to management, wrote incident forms etc.

The first care assistant had to do a one to one with a patient who was licking the floors, hitting other patients, screaming the place down, arguing with a toilet and beating the staff. He could not be controlled. Psyche wouldn't see him and the doctors were hesitant to prescribe sedative type medication due to certain issues. The medics said his problems were psyche and the psychiatric people said that his problems were medical. No one was taking ownership. The ward nurses were left to manage him. RGN's are not RMN's. We are not trained to deal with this shit nor can we restrain people etc. This is a whole 'nother blog post right here.

The second care assistant had to escort a patient to a procedure off ward. The patient was confused and incontinant. The people in the procedures department will not deal with this and refused to carry out the said test unless patient was escorted by ward staff. This test was paramount. The nurse would have been in deep shit if she tried to keep the care assistant on the ward and patient missed the test. They were gone for 3 hours in the morning.

The third care assistant was trying to bed bath, toilet, and assist 36 patients herself. Most of these people cannot be cleaned or even get onto a bed pan or commode unless you have at least two staff lifting. It is physically impossible.

The 2 nurses each had 18 patients with more drugs, and orders that they could handle. The nurses alerted the powers that be to the fact that they needed help and they needed it now.

The 2 nurses flew through the drug round in an unsafe manner. They did a 10 second assessment of each patient to ensure that they were stable. Then they had to decide what to "ditch".

All the patients were stable and the most important meds/interventions were mostly caught up at this point. The next priority on the nurses' list was helping the lone care assistant. They grabbed pinnys and went off to bed bath and toilet and feed. Otherwise those patients would have been left for hours and hours and hours. Even with all 3 staff on board working like dogs those patients still would have been left for too long.

Yes, the nurses decided that once the patients were stable and the most important interventions were out of the way that they would make BASIC CARE the top priority. But something had to be "ditched" in order to pull this off.

They ditched the discharges (clogging up a&e as a result), all paperwork, phone calls, and doctors rounds and lots of other stuff. Discharging patients is very very time consuming these days. It keeps you away from your other patients for a long time. They had to ditch the discharges etc. Otherwise the other patients and their lone care assistant would have been fucked.

2PM rolls around. These nurses started their shift at 0700. By 2Pm they were finishing the bed baths. They had not had any kind of break, the ward was in pandemonium due to phone calls, doctors rounds, discharges and other jobs being ditched. Meals barely got out, and now lunchtime meds were late. These nurses were in big big trouble.

But the patients were safe and clean.

At 2:30 the 2 nurses were cleaning, dressing and changing the 5 day old dressings on their last patient. They were hungry and feeling faint. The awesome and hardworking lone care assistant was walking someone to the toilet. This patient walks so slowly that it takes a long time to get her to the toilets. So many call bells were ringing at this moment in time. Patients were crying for help.

It was at this time that a gaggle clipboard carrying fuckhead modern matron type "nurses" who are not ward based walked onto the ward and stopped just outside the curtain where our two hero nurses were busting their asses.

The gaggle (there was about 5 of them) commented about the fact that the paperwork was a mess on the ward and that the nurses needed to be "spoken to harshly".

They commented about the colour of the curtains and whether they matched the floor. This was the main topic of conversation.

They discussed the fact that there were no coloured magnets on the board to identify which patients could be moved so that targets could be met. Then they left. They just left.

What is the point of this very true anecdote?

Our 2 superhero ward nurses took a big risk and worked hard to make sure the patients had basic care. These two ward nurses are modern degreeeducated nurses. Both of them are about 28 years old.

The gaggle of clipboard carrying fuckhead matron type "nurses" who abandoned our heros and walked off the ward discussing curtains were all trained before 1985. Most of them trained in the 1970's. Yours truly is too young to even remember the 70's. The whole goddamn group of them were old school trained. They didn't talk to a patient or offer to help our two heroes. They all just walked away. They discussed curtains and punishing the nurses for not doing paperwork and then they walked away. Fucking whores. What the hell kind of fucking sociopathic sickos did these old time hospital based nursing schools churn out? These 5 people knew the situation on that ward with the staffing and the mental health patient. They absolutely did. They were the ones who told the ward nurses that no help was available.

Things may be far from perfect now but at least they have standards for people to qualify as nurses today. Jesus Christ.

The old school nurses who are still on the wards are fabulous.

The nasty evil horrible ones who hate nursing get given clipboards and big salaries. And we know which ones shag the managers.

These nutters are the ones who bleat on about "today's nurses". You won't often hear that shit coming from the old school nurses who are actually still on the wards. Those comments usually only comes from those who haven't done ward nursing since 1983.

I see this stuff all the time myself. That is why I believe it. This is why I will not tolerate this bullshit about degree educated nurses not caring about basic care and patient dignity. The vast majority of nurses are old school trained. The vast minority are degree trained. Those clipboard carrying worthless twits that you see walking around hospitals these days are OLD SCHOOL TRAINED.

9 comments:

Exactly. I'm a degree-educated nurse and I'm passionate about good-quality basic care. I'd be horrified if anyone thought I was too important to wipe a backside, and go to great lengths to demonstrate that's not the case.

Me too. That is why I get so mad when I am busy and have unstable patients and no help. It makes the stable patients who just need a little help with personal care think that I am ignoring them, or don't care about them. Makes me cry.

"I see this stuff all the time myself. That is why I believe it. This is why I will not tolerate this bullshit about degree educated nurses not caring about basic care and patient dignity."

I see this myself where I work...and I totally agree. The 'old school' nurses on the wards are fabulous...but those who have moved into management roles have no idea any more.. In their day things were different:

i.e LESS patients, MORE staff. No IMPOSSIBLE targets to meet, all necessary equipment on hand, relatives having a certain amount of respect as appose to constant negative questioning (which is so time consuming for the nurse and removes her from the bedside even longer)

Good quality basic care is my priority. But 'the forces that be' get in the way...and I (and therefore my patients) have to make do with what I can.

Honestly - it doesnt matter when you were trained or by what method - either you have the heart of a nurse - ie you immediately move to help/care for patients when you see a need whatever your *station* in life - or you have NO nurse's heart and you hide in an office and stay clear at all costs. Anne I like reading your posts - I am mortified by the care in NHS now - I was an "old school" nurse (I suppose) trained in 70s in UK - and I will say again that all this crap started once the students went into college based programs and they were NEVER replaced in the workforce. I am working in USA now and as a nurse manager, director, executive I have always staffed my areas appropriately and stood up for my nurses and never let a physician abuse anyone! without my immediate intervention (including instructing nurses to page me the second he started to misbehave and me racing out of a meeting to nail the bastard in the act!) ands escalating the issue to Med Dept Heads and CEO of hospital as required - I just will not stand for it and have always had excellent results - they back down and change their tune when you get in their face and dont show any fear! However I have worked with many lazy unconcerned self serving and indifferent nurses, managers etc. It has to come from the top and care must not be compromised - however it can be a fight!

Fantastic blog! Do you have any helpful hints for aspiring writers?I'm planning to start my own website soon but I'm a little lost on everything.Would you advise starting with a free platform like Wordpress or go for a paid option? There are so many choices out there that I'm totally confused .. Any ideas? Thanks a lot!

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.